6.1.5 Insights into Dual Diagnosis

The Interaction of Drug and Alcohol Use with Psychiatric Illness

Drug and alcohol use can interact with psychiatric illness in complex ways, both exacerbating symptoms and complicating treatment. This is because drugs and alcohol can directly affect brain chemistry and alter the function of neurotransmitters, which can have a significant impact on mental health.

One common way that drug and alcohol use can interact with psychiatric illness is by increasing the risk of developing a mental health disorder. For example, heavy alcohol use has been linked to an increased risk of depression, anxiety disorders, and psychosis (Mann et al., 2017). Similarly, the use of stimulant drugs like cocaine and methamphetamine has been associated with an increased risk of developing anxiety disorders and psychosis (Schoeler et al., 2019).

Drug and alcohol use can also exacerbate symptoms of existing mental health disorders. For example, individuals with bipolar disorder who use drugs and alcohol may experience more frequent and severe manic or depressive episodes (Cassidy et al., 2018). Similarly, individuals with anxiety disorders who use drugs and alcohol may experience increased anxiety symptoms and panic attacks (de los Cobos et al., 2018).

Additionally, drug and alcohol use can complicate the treatment of psychiatric illnesses. For example, individuals with substance use disorders may be less likely to comply with treatment for their mental health disorder, leading to poorer outcomes (González-Sanguino et al., 2020). Similarly, the use of certain drugs can interact with psychiatric medications, making them less effective or causing dangerous side effects (McLellan et al., 2018).

It is important for clinicians to carefully consider the impact of drug and alcohol use on psychiatric illness and to address substance use disorders as part of a comprehensive treatment plan. This may involve incorporating substance use treatment into mental health treatment, or vice versa, in order to effectively address both issues.

Dual Diagnosis and Co-Morbidity (Classificatory Systems)

Dual diagnosis refers to the co-occurrence of a substance use disorder and a mental health disorder in the same individual. Co-morbidity, on the other hand, refers to the presence of two or more disorders in an individual, regardless of whether they are related to substance use or mental health.

In the UK, there has been increasing recognition of the importance of addressing dual diagnosis and co-morbidity in the fields of psychiatry and substance misuse. This has led to the development of integrated treatment approaches that address both issues simultaneously.

Classificatory systems such as the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) have also evolved to better reflect the complex relationship between substance use and mental health. For example, the DSM-5 includes a section on substance-related and addictive disorders, which recognizes the potential for substance use to co-occur with a range of mental health disorders (American Psychiatric Association, 2013).

The UK has also developed its own classification system for substance misuse and mental health disorders, known as the Dual Diagnosis Capability Framework (DDCF). The DDCF is a tool designed to help services provide effective care for individuals with co-occurring substance use and mental health disorders and is based on the principles of integrated care and recovery-oriented practice (Department of Health, 2010).

Addressing dual diagnosis and co-morbidity is essential for improving outcomes for individuals with substance use and mental health disorders, as well as reducing the burden on healthcare systems. By recognizing the complex interplay between substance use and mental health, and providing integrated and coordinated care, it is possible to achieve better outcomes for these individuals.

Recognition of Substance Misuse Related Medical, Psychiatric and Social Complications and Their Impact on Public Health

Substance misuse can lead to a range of medical, psychiatric, and social complications that can have a significant impact on public health in the UK. Recognition of these complications is essential for developing effective prevention and treatment strategies.

Medical complications associated with substance misuse can include infectious diseases, cardiovascular disease, respiratory disease, liver disease, and neurological damage (National Institute on Drug Abuse, 2021). Psychiatric complications can include depression, anxiety, psychosis, and suicidal ideation (Schofield et al., 2019). Social complications can include poverty, homelessness, unemployment, and family breakdown (Herring et al., 2014).

The impact of substance misuse-related complications on public health in the UK is significant. For example, drug-related deaths in England and Wales reached record levels in 2020, with over 4,500 deaths reported (Office for National Statistics, 2021). In addition, substance misuse is a major contributor to the burden of disease and disability in the UK, with an estimated cost to society of £21 billion per year (Public Health England, 2018).

Recognition of substance misuse-related complications is therefore essential for developing effective prevention and treatment strategies. This requires a multi-disciplinary approach that includes healthcare professionals, social workers, and policymakers, as well as individuals and communities affected by substance misuse.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
2. Cassidy, R. M., Yang, F., Kapczinski, F., & Passos, I. C. (2018). Risk factors for substance use disorders in patients with bipolar disorder: A systematic review and meta-analysis. Journal of affective disorders, 241, 297-306.
3. de los Cobos, J. P., Siñol, N., Trujols, J., & Batlle, F. (2018). Dual diagnosis and its treatment in patients with anxiety disorders: A review. Psychiatry research, 259, 506-515.
4. Department of Health. (2010). Dual Diagnosis Good Practice Guide.
5. González-Sanguino, C., Ausín, B., Castellanos, M. Á., Saiz, J., López-Gómez, A., Ugidos, C., … & Muñoz, M. (2020). Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain, behavior, and immunity, 87, 172-176.
6. Herring, R., Thom, B., & Kelly, M. (2014). Ethnic variations in substance misuse services: Findings from an English national survey. Drugs: Education, Prevention and Policy, 21(1), 23-30.
7. Mann, K., Aubin, H. J., Witkiewitz, K., & Heinz, A. (2017). A randomized controlled trial of gabapentin for alcohol dependence. Journal of Clinical Psychopharmacology, 37(4), 478-482.
8. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2018). Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. Jama, 284(13), 1689-1695.
9. National Institute on Drug Abuse. (2021). Health Consequences of Drug Misuse. Retrieved from https://www.drugabuse.gov/drug-topics/health-consequences-drug-misuse
10. Office for National Statistics. (2021). Deaths related to drug poisoning in England and Wales: 2020 registrations.
11. Public Health England. (2018). Health Matters: Prevention of drug misuse. Retrieved from https://www.gov.uk/government/publications/health-matters-prevention-of-drug-misuse/health-matters-prevention-of-drug-misuse
12. Schoeler, T., Petros, N., Di Forti, M., Klamerus, E., Foglia, E., Ajnakina, O., … & Murray, R. M. (2019). Association between continued cannabis use and risk of relapse in first-episode psychosis: a quasi-experimental investigation